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Discharging their responsibilities



According to a senior coroner commenting on a tragic and dysfunctional Liverpudlian death, medical care would be enhanced by sending a copy of the patient’s discharge letter to all primary, secondary and tertiary parties involved.

Well, simply sending one to the GP would be a start. As for scatter-gunning discharge letters to all-comers? Hmmmm, good idea. Probably. Possibly. Possibly not. In fact, no, don’t.

Though well-intentioned, this suggestion makes the common mistake of assuming that more communication equals better communication. It doesn’t.

Just check out the state of primary care records these days: they’ve become a data-dumping ground for anyone who has access (which is everyone), with the result being that they’re now a grotesquely bloated and utterly impenetrable parody of their former selves.

Whether through iatrogenesis or neglect, the outcome remains the same

And the more noise there is to signal, the more likely you’ll overlook something significant – that is, until you receive an invitation from the coroner to explain, say, why you prescribed Augmentin to a patient with a history of penicillin-induced anaphylaxis, which is news to you because, of course, you haven’t received a discharge letter. Or, in this case, the death notification.

As for those discharge letters themselves, the current trend is to churn out four-page monsters with the cut and paste ‘Investigations’ section trumped in length only by the ‘GP to do’ list.

And somewhere, buried in this disordered, unedited and thoughtless mess, is the odd unhighlighted and unmanaged shocker, such as, to give you a recent example, ‘…likely pancreatic cancer with bony mets…’

So, sure, send this out to everyone involved. Trouble is, until the message is improved rather than multiplied, you just end up with more recipients scratching their heads.

And action? At best it’ll be triplicated. At worst it’ll be ignored, as each waits for the other to act. And, whether through iatrogenesis or neglect, the outcome remains the same. Which brings us neatly back to the coroner.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield or follow him on Twitter @doccopperfield